Safety Considerations in Aesthetic Rib Surgery: A Review of Risks and Technical Refinements

Background: Aesthetic rib surgery, including rib resection and rib remodeling, has recently emerged as a niche procedure for body contouring and waistline refinement. Despite increasing demand, its safety profile remains poorly defined. Methods: A focused narrative review was conducted, synthesizing recent systematic reviews, anatomical studies, and clinical series published between 2015 and 2025. Outcomes analyzed included intraoperative and postoperative complications, pain, respiratory function, and patient satisfaction across traditional rib resection and minimally invasive remodeling techniques. Results: Traditional rib resection is associated with pneumothorax, hemothorax, chronic pain, infection, and contour asymmetry. Pneumothorax and hemothorax, though infrequent, are the most severe due to pleural proximity. Intercostal nerve trauma may lead to chronic pain or paresthesia. Minimally invasive remodeling methods—such as rib shaving, in situ splitting, and greenstick fractures—demonstrate significantly fewer complications, lower pain scores, and faster recovery times. Anatomical studies confirm that harvesting costal cartilage from the ninth and tenth ribs minimizes pneumothorax risk due to muscular protection by the transversus abdominis. Conclusions: The safety of aesthetic rib surgery is highly dependent on technique. Rib remodeling without complete resection offers a favorable risk–benefit ratio, minimizing major complications and preserving thoracic stability. Careful patient selection, precise dissection, and comprehensive preoperative counseling are essential to optimize outcomes and ensure ethical application.